Achieving Global Health Equality Within a Generation

If we make the right investments in the health sector today, we could achieve universally low rates of infectious, maternal and child deaths by 2035.
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Lawrence H. Summers is President Emeritus and Charles W. Eliot University Professor of Harvard University and former U.S. Treasury Secretary. He is the chair of The Lancet Commission on Investing in Health,

Gavin Yamey is Associate Professor of Epidemiology and Biostatistics in the Global Health Group at the University of California, San Francisco, and a member of The Lancet Commission on Investing in Health.

We are on the cusp of a once in human history achievement.

When looking at the broad sweep of human history, people's health status was relatively similar across the world. Death rates for mothers and children were high, life expectancy was short, and health status was poor. This was the universal condition.

Only in the past two centuries have we seen the world diverge.

Advancements in science and investments in public health have brought vastly improved health conditions to citizens in the rich, Western world, leaving those in the poorest countries behind. The result was "a great divergence" in global health -- reaching a point now where only one in 150 children in the United States or Britain dies before the age of five versus a rate of one in 10 children in the world's poorest counties.

But we are now at a remarkable inflection point in history.

A new report published in The Lancet, called Global Health 2035, which we co-authored along with 23 renowned economists and health experts, shows that if we make the right investments in the health sector today, we could achieve universally low rates of infectious, maternal and child deaths by 2035. In other words, we could shift directions to achieve a "grand convergence" in global health within just one generation.

We have the financial and the ever-improving technological capabilities to ensure that a child born anywhere in the world can live a long, healthy life.

By making sure life-saving medicines, vaccines, malaria bed nets, diagnostic tests and other health tools are delivered to everyone, we could dramatically cut deaths caused by the traditional scourges of the poor world -- like AIDS, TB, malaria, and childhood pneumonia and diarrhea -- to low levels everywhere.

Achieving such a grand convergence would close the global health gap and save roughly 10 million lives a year in 2035 and onwards -- while simultaneously increasing human productivity and boosting economic growth.

Perhaps the most striking finding of The Lancet report is that the economic payoff from investing in a grand convergence would be enormous. We used new research methods from health economics to put a dollar amount on the direct value of greater survival. We found that every one dollar invested in achieving the grand convergence over the period 2015-2035 would return between 9 and 20 dollars. This return on investment is nothing short of astonishing. In financial markets, investments with foreseeable returns of between 9 to 1 and 20 to 1 over reasonable time horizons simply do not exist.

Investing in a grand convergence is not a high risk venture capitalist system that could fail. History shows that low- and middle-income countries who work hard to ensure that everyone receives life-saving health tools and services can rapidly reduce their death rates. For example, Chile, China, Costa Rica and Cuba (the "4C countries") were all classified as low-income or lower-middle- income in 1990 and yet they managed to achieve high levels of health status by 2011 through health sector investments. Incredibly, since 1980, the likelihood of a baby born in China living to age five has improved from being on par with Botswana to being roughly equal to Britain and the United States.

Of course, saving 10 million lives a year will cost money -- about 70 billion dollars per year of health investments. But the report finds some other good news: that cost represents less than one percent of the additional GDP that will be available to low- and lower-middle-income countries due to increased GDP growth over the next 20 years. Let's repeat that. An investment by governments of less than one percent of GDP would avert 10 million deaths. That surely represents the greatest opportunity available on the planet to improve human welfare.

There are a number of bold new policies that countries should adopt now in order to help them reap these dramatic benefits. The Commission found that a series of innovative public policies--such as taxing harmful substances like tobacco, sugar-sweetened beverages, and alcohol, and reducing fossil fuel subsidies -- would create new funding streams for health. They would also help to curb deaths from chronic diseases like cancers, heart disease, and lung disease. A tax on tobacco is the single most powerful lever for curbing chronic diseases and could raise significant public revenue for basic health care. For example, a 50 percent tobacco tax in China over the next 50 years would raise US $20 billion annually and save 20 million lives.

When it comes to clean air, many countries have large energy subsidies on air-polluting fossil fuels that encourage the pollution that shortens lives. In sub-Saharan Africa, such subsidies account for an astounding 3.5 percent of GDP on a post-tax basis. Global Health 2035 argued that countries with these or other unwarranted subsidies should reduce or eliminate them--which would have the dual benefits of reducing deaths from heart and lung diseases and creating more budgetary room for high-priority public health spending.

These findings should serve as a wake-up call not just to governments in low- and middle-income countries but to the wider international community. Our global health system needs to be restructured to help achieve these dramatic health gains.

Though low-income countries will still need direct financial support, we should begin to shift global health aid to providing global public goods. We must double our investment in research and development for vaccines, diagnostics and drugs for those conditions causing the most deaths in the poor world. We must invest more heavily in what is called "implementation science"--the identification of the most cost effective modes of treatment in different kinds of environments. And we must start to get serious about tackling cross-border threats, like antibiotic resistance, counterfeit medicines, and flu pandemics. The next flu pandemic could be far deadlier than the 1918 epidemic that killed 50 million people in an era before mass, international transit.

Our report will not be the last report ever written on global health. There will be challenges for as long as anyone can foresee. But there's only one time in history when we will have the prospect of a grand convergence in health. That time is now. We can afford it. We know how to do it. Now let's get the job done.


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